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What are the changes to eyes that take place to the elderly?
- -Pupil size decreases
- -Presbyopia, ¯ visual acuity, ¯ night vision
- -Diminished visual functioning causes:
- •Cataract formation
- •Macular degeneration
- •Loss of central vision
In what instances do Palpebral fissures look different?
- -Persons of Asian origin
- -Down syndrome
What is the first test you should do when examining the eyes?
Which external eye structures do you examine?
- -General: begin with external points, work inward
- -Eyelids and lashes
- -Conjunctiva and sclera
- -Lacrimal apparatus
Which anterior eyeball structures do you inspect?
- -Cornea and lens
- -Iris and pupil:
- •Size and shape
- •Pupillary light reflex
When you inspect the ocular fundus using an ophthalmoscope what are you looking for?
What may happen to visual acuity as a part of the aging process?
•Central acuity may decrease, particularly after 70 years of age; peripheral vision may be diminished
What can happen to ocular structures as a part of aging?
•Eyebrows may show loss of outer one third to one half of hair because of decrease in hair follicles; remaining brow hair is coarse
•As result of atrophy of elastic tissues, skin around eyes may show wrinkles or crow’s feet; upper lid may be so elongated as to rest on lashes, resulting in pseudoptosis
•Eyes may appear sunken from atrophy of orbital fat; orbital fat may herniate, causing bulging at lower lids and inner third of upper lids
•Lacrimal apparatus may decrease tear production, causing eyes to look dry and lusterless and person to report a burning sensation
- •Pingueculae commonly show on sclera
- •Cornea may look cloudy with age
•Arcus senilis commonly seen around cornea
•Xanthelasma: soft, raised yellow plaques occurring on lids at inner canthus
•Pupils small in old age; pupillary light reflex may be slowed
•Lens loses transparency and looks opaque
What typically happens to the ocular fundus as a part of aging?
•Retinal structures generally have less shine; blood vessels look paler, narrower, and attenuated; arterioles appear paler and straighter, with a narrower light reflex
•Drusen, or benign degenerative hyaline deposits are normal development on retinal surface
What is Exophthalmos?
What is Enophthalmos?
What are the abnormal findings of vascular disorders of the external eye?
- -Subconjunctival hemorrhage
- -Iritis, circumcorneal redness
- -Acute glaucoma
Can you inspect the inner ear?
No but you can asses its functions
What are the 3 levels of the auditory system?
- •Cerebral cortex
What are the pathways of hearing?
- •Air conduction
- •Bone conduction
What kind of hearing loss is there?
- •Conductive- involves a mechanical dysfunction of external or middle ear
- •Sensorineural (or perceptive) -signifies pathology of inner ear, cranial nerve VIII, or auditory areas of cerebral cortex
- •Mixed-combination of conductive and sensorineural types in same ear
What happens to hearing as adults age?
-Cilia lining ear canal become coarse and stiff
- -Presbycusis: type of hearing loss that occurs with aging, even in people living in quiet
What is otitis media?
-Obstruction of eustachian tube or passage of nasopharyngeal secretions into middle ear
What is the function of the nose?
warms, moistens, and filters the inhaled air and is the sensory organ for smell.
What are the four Paranasal sinuses?
What are the structures of the mouth?
- -Hard and soft palates
What are the locations of the salivary glands?
What are the areas of the throat?
What are the changes that take place within the nose, throat and mouth with regard to aging?
- -Diminished smell and taste
- -Problems may lead to altered nutrition
- -Gum loss, Dental changes
- -Nose becomes more prominent
What are Epistaxis?
What is the grading of the tonsils?
2+Halfway b/w tonsillar pillars and uvula
3+Touching the uvula
4+Touching each other
What is the most common site of a nosebleed?
If an infants nostrils are flaring what does this indicate?
What is the fastest growing cancer?
What is the accommodation of the eye for near vision?
By increasing the curvature of the lens through movement of the ciliary muscles
What is the preferred side for the patient to be on when giving an enema?
Their left side due to the descending colon.
How do you divide the abdomen?
-Into 4 quadrants, RUQ, LUQ, RLQ, LLQ
What organs are a part of the Solid Viscera?
- oAdrenal glands
What organs are a part of the hollow viscera?
- oSmall Intestine
What structures are in the RUQ?
- -Head of pancreas
- -Right kidney and adrenal gland
- -Hepatic flexure of colon
- Part of ascending and transverse colon
What structures are in the LUQ?
- -Left lobe of liver
- -Body of pancreas
- -Left kidney and adrenal gland
- -Splenic flexure of colon
- -Part of transverse and descending colon
What structures are in the RLQ?
- -Right ovary and tube
- -Right ureter
- -Right spermatic cord
What structures are in the LLQ?
- -Part of descending colon
- -Sigmoid colon
- -Left ovary and tube
- -Left ureter
- -Left spermatic cord
What structures are in the midline?
- -Uterus, if enlarged
- -Bladder, if distended
What is a common signs of pregnancy?
-heartburn (pyrosis) caused by esophageal reflux
-Constipation and increased venous pressure in lower pelvis may lead to hemorrhoids
When should you palpate painful areas during a physical examination?
What do we look for when we inspect the abdomen?
- -Contour: Flat, scaphoid, rounded, protuberant
- -Skin: color, striae, lesions, scars
- -Pulsation or Movement
- -Hair Distribution
What might you notice when inspecting an abdomen of an older adult?
- oOn inspection, you may note increased deposits of subcutaneous fat on abdomen and hips because it is redistributed away from extremities
- oAbdominal musculature is thinner and has less tone than that of younger adult, so you may note peristalsis
- oBecause of thinner, softer abdominal wall, organs may be easier to palpate
- oLiver and kidneys are easier to palpate
What is the small intestine used for and what are the sections?
–Absorption of nutrients and electrolytes
- 3 Sections
What is the main function of the large intestine?
- Absorb water and electrolytes
-Main function is elimination
What is the process of bowel elimination?
- •Defecation – process of elimination of waste
- •Feces – semi-solid mass of fiber, undigested food, inorganic material, etc.
- •Fecal material reaches rectum
- •Stretch receptors initiate contraction of sigmoid colon/rectal muscles
- •Internal anal sphincter relaxes
- •Sensory impulses cause voluntary “bearing down” – Valsalva’s maneuver
- •External sphincter relaxes
What are common alterations in defecation?
- •Fecal impaction
- •Bowel diversions – colostomy
What is the purpose of enemas?
- •Main purpose is the promotion of defecation, stimulate peristalsis
- •Fluid breaks up fecal mass, stretches the rectal wall and initiates defecation reflex
What is the thyroid gland used for?
Synthesizes and secretes thyroxine (T4)and triiodothyronine (T3), which are hormones that stimulate rate of cellular metabolism
Where are the lymphatic nodes?
- ◦Posterior auricular (mastoid)
- ◦Superficial cervical
- ◦Deep cervical
- ◦Posterior cervical
What happens to the face when people get older?
-Facial bones and orbits appear more prominent
- -Facial skin sags- resulting from
- ◦decreased elasticity
- ◦decreased subcutaneous fat
- ◦decreased moisture in skin
-Lower face may look smaller if teeth have been lost